Methods: The multidisciplinary Antibiotic Stewardship Program (ASP) at Barnes-Jewish West County Hospital, a 77-bed facility, developed and disseminated guidelines for ciprofloxacin use to all physicians via an electronic newsletter and in-person meetings with provider groups identified as having high ciprofloxacin utilization rates beginning in 6/2017. Included in the guidelines were recommendations for more effective, safer alternatives to ciprofloxacin for common infection types. In 12/2017, the ASP pharmacist initiated prospective audit and feedback (PAF) for all ciprofloxacin orders. Ciprofloxacin utilization was measured monthly in days of therapy (DOT)/1,000 patient (pt) days utilizing medication administration data. Patient days were determined according to National Healthcare Safety Network (NHSN) conventions.
Results: During the pre-intervention period (6/2015 to 6/2017), ciprofloxacin utilization rates averaged 73.3 DOT/1000 pt days, but in May 2017, use increased to 138.3. Following provider education, average utilization decreased to 56.9 DOT/1000 pt days from 9/2017 to 11/2017. With the addition of PAF, average ciprofloxacin utilization decreased to 43.6 DOT/1000 pt days from 12/2017 to 3/2018, a 41% reduction compared to the pre-intervention period. Utilization of other fluoroquinolones did not increase.
Conclusion: Education was a useful tool in reducing inappropriate ciprofloxacin use; however, a combination of prospective audit and feedback with education achieved the greatest impact on curbing ciprofloxacin use. This multimodal approach was effective and sustainable at a small hospital with limited antibiotic stewardship resources.
A. M. Thompson,
H. Newland, None
J. Feldmann, None
S. Y. Liang, None
See more of: Poster Abstract Session